Provider Demographics
NPI:1306832142
Name:IRBY, CHERISE A (MD)
Entity Type:Individual
Prefix:DR
First Name:CHERISE
Middle Name:A
Last Name:IRBY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 FAIRFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4436
Mailing Address - Country:US
Mailing Address - Phone:318-629-4729
Mailing Address - Fax:318-629-4730
Practice Address - Street 1:1905 FAIRFIELD AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4436
Practice Address - Country:US
Practice Address - Phone:318-629-4729
Practice Address - Fax:318-629-4730
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2009-11-20
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
LA24995207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA0402562OtherUNITED HEALTHCARE
LA7483495OtherAETNA
LA1423301Medicaid
LA273431OtherCOVENTRY
LAP00023608OtherRAILROAD MEDICARE
LA4F159CF83Medicare PIN
LA7483495OtherAETNA